Problem of Foreign Body in GI Tract

Most foreign bodies pass through the gastrointestinal tract uneventful. We report of a case of inadvertently ingested foreign body, which by endoscopy simulated a polyp and on biopsy reported as cancer, so the patient underwent an unnecessary major operation. This report emphasizes the importance of resemblance of foreign bodies with gastrointestinal neoplasm, and endoscopists, surgeons and pathologists should consider this entity in their daily practice

Introducing novel and comprehensive models for predicting recurrence in breast cancer using the group LASSO approach: are estimates of early and late recurrence different?

BACKGROUND: In here, we constructed personalized models for predicting breast cancer (BC) recurrence according to timing of recurrence (as early and late recurrence). METHODS: An efficient algorithm called group LASSO was used for simultaneous variable selection and risk factor prediction in a logistic regression model. RESULTS: For recurrence  5 years, stage 2 cancer (OR 1.67, 95% CI = 1.31-2.14) and radiotherapy+mastectomy (OR 2.45, 95% CI = 1.81-3.32) were significant predictors; furthermore, relative to mastectomy without radiotherapy (as reference for comparison), quadranectomy without radiotherapy had a noticeably higher odds ratio compared to quadranectomy with radiotherapy for recurrence > 5 years (OR 7.62, 95% CI = 1.52-38.15 vs. OR 1.75, 95% CI = 1.32-2.32). Accuracy, sensitivity, and specificity of the model were 71%, 78.8%, and 55.8%, respectively. CONCLUSION: For the first time, we constructed models for estimating recurrence based on timing of recurrence which are among the most applicable models with excellent accuracy (> 80%)

Survival analysis of 1148 women diagnosed with breast cancer in Southern Iran

Background: while there has been much research regarding risk factors and prognostic factors for breast cancer in general, research specific to Iran is sparse. Further, the association between breast cancer survival and socio-demographic and pathologic factors has been widely studied but the majority of these studies are from developed countries. Southern Iran has a population of approximately 4 million. To date, no research has been performed to determine breast cancer survival and to explore the association between the survival and socio-demographic and pathologic factors in Southern Iran, where this study was conducted.Methods: the data were obtained from the cancer registry in Fars province, Southern Iran and included 1148 women diagnosed with breast cancer between 2000 and 2005. The association between survival, and sociodemographic and pathological factors, distant metastasis at diagnosis, and treatment options was investigated using Cox regression.Results: the majority of patients were diagnosed with an advanced tumour size. Five-year overall survival was 58% (95%CI; 53%–62%). Cox regression showed that family income (good vs poor: hazard ratio 0.46, 95%CI; 0.23–0.90) smoking (HR = 1.40, 95%CI; 1.07–1.86), metastases to bone (HR = 2.25, 95%CI; 1.43–3.52) and lung (HR = 3.21, 95%CI;1.70–6.05), tumour size (? 2 cm vs ? 5 cm: HR = 2.07, 95%CI;1.39–3.09) and grade (poorly vs well differentiated HR = 2.33, 95%CI; 1.52– 3.37), lymph node ratio (0 vs 1: HR = 15.31, 95%CI; 8.89–26.33) and number of involved node (1 vs >15: HR = 14.98, 95%CI; 8.83–25.33) were significantly related to survival.Conclusion: this is the first study to evaluate breast cancer survival in Southern Iran and has used a wide range of explanatory factors, 44. The results demonstrate that survival is relatively poor and is associated with diagnosis with late stage disease. We hypothesise that this is due to low level of awareness, lack of screening programs and subsequent late access to treatment

Pancreatic Metastasis from Rectal Gastrointestinal Stromal Tumor: A Case Report

Gastrointestinal stromal tumors are mesenchymal neoplasms of the gastrointestinal tract that originate from all areas of the gastrointestinal tract. Metastases to the liver, peritoneum, bones, lungs and soft tissues have been reported. We present the case of a 47- year-old woman with rectal gastrointestinal stromal tumor that underwent wide local excision. She was treated with imatinib for a few months after surgery. After eight months, she was admitted to the emergency service with complaints of epigastric pain, nausea, vomiting, and anorexia. Imaging studies showed the presence of a pancreatic head tumor and three hepatic masses. The patient underwent exploratory laparatomy. Excisional biopsy of one hepatic mass and core needle biopsy of the pancreatic head mass revealed metastases to the liver and pancreas. During the hospital course the patient's condition deteriorated and she subsequently expired

Combined Methylene Blue Dye andRadioactive Tracer Technique for Sentinel Lymph Node Localization in Early Breast Cancer

Background: Sentinel lymph node biopsy is a technique used to identify the axillary node most likely to contain tumor cells that have metastasized from a primarycarcinoma of the breast. This technique provides accurate staging with fewer complications than axillary dissection and may result in decreased costs. We designed the present study to determine the accuracy and success rate of a combined blue dyeand radioactive tracer technique in sentinel node localization. Methods: This prospective study included 70 patients with early stage (tumor>5cm; T1, T2) operable breast cancer and nonpalpable axillary lymphadenopathy seen between 2005 and 2009. Patients underwent sentinel lymph node localization using 4mL of blue dye combined with radioactive colloid. After identification and removal of the sentinel node(s), the axilla was checked for any residual radioactivity. A sentinelnode was defined as any node that was hot, hot and blue or only blue.Results:The sentinel node was identified in 66 patients with a detection rate of 94.2%,and a mean of 1.5 sentinel nodes were identified and harvested (range of 1-4). In 23cases, the sentinel lymph node contained metastatic disease on pathological assessment.There was no pathological evidence of any metastases in the sentinel node in the remaining 43 patients. All sentinel lymph nodes were located in level I of the axillary region. In four patients, no sentinel lymph node was found, so axillary dissection was performed. The sensitivity of the procedure in predicting further axillary disease was 95.6% with a specificity of 97.6%.Conclusion: The present study describes the blue dye and radioisotope localization technique as successful in identifying the sentinel lymph node in early-stage breast cancer patients

Increased IL-17 and IL-6 Transcripts in Peripheral Blood Mononuclear Cells: Implication for a Robust Proinflammatory Response in Early Stages of Breast Cancer

Background: Several recent studies demonstrated that transforming growth factor beta (TGF-β), by stimulating T regulatory cells, and interleukins 6 and 17 (IL-6, IL-17), by inducing inflammatory reactions, may be critical factors in cancer pathogenesis. Methods: We used quantitative real-time polymerase chain reaction assays to quantify the expression of IL-17, IL-6 and TGF-β mRNA in peripheral blood mononuclear cells and lymphocytes from draining lymph nodes of 60 women with breast cancer. The results were compared according to the patients’ clinical or pathological status. Results: Higher amounts of IL-17 and IL-6 mRNA, but not TGF-β transcripts, were found in patients compared to controls. There were no significant differences between patients with negative or positive nodes or with different histological grades or stages of disease. Conclusion: Most women in this analysis had stage I or II disease. We thus conclude that IL-17, a prominent proinflammatory cytokine, may play an important role in recruiting and infiltrating antitumor immune responses in early stages of breast cancer

Evaluation of the Effect of a Preoperative Single Dose of Gabapentin on Emergence Agitation in Patients Undergoing Breast Cancer Surgery

Background: Emergence agitation is a transient confusional state that usuallyoccurs within 10 to 30 minutes of recovery from general anesthesia. It may lead to seriousconsequences and increasing hospital costs. This study evaluates the effect of gabapentinon emergence agitation in patients undergoing breast cancer surgery.Methods: This randomized, double blind controlled trial enrolled 100 femalepatients with American Society of Anesthesiologists' classifications I and II who werecandidates for breast cancer surgery. Patients were randomly assigned into two groups(n=50) that received either oral gabapentin 600 mg or placebo. Induction andmaintenance of anesthesia were similar in both groups. At the end of surgery, patient'sagitation score, pain score, and presence of nausea or vomiting were reported. In theward, the presence of headache or dizziness was checked during the first 8 h. Mann-Whitney test was used for comparison of agitation and pain scores between two groups.Chi-square test was used for comparing occurrence of nausea, vomiting and qualitative.The qualitative demographic variable and t-test compared quantitative demographicvariables.Results: There was a significantly lower incidence of emergence agitation in thegabapentin group before (P<0.001) and after (P=0.029) extubation. There weresignificantly lower mean agitation scores before (P<001) and after (P=0.006) extubationand in the pain score (P=0.005) in the gabapentin group. The need for remifentanilinfusion (P<0.05) during surgery was significantly lower in the gabapentin groupcompared with the placebo group. Occurrence of nausea and vomiting and gabapentinside effects that included headache or dizziness did not significantly differ between twogroups (P=0.126, P=1, P=0.629 respectively).Conclusion: Gabapentin not only decreased postoperative pain but also effectivelyreduced emergence agitation without any significant side effects in patients undergoingbreast cancer surgery

Investigation of Prognostic Factors and Survival without Recurrence in Patients with Breast Cancer

Background: One of the major consequences of breast cancer is the recurrence of the disease. The objective of present study was to estimate the 7-year survival without recurrence as well as the effective prognostic factors in recurrence. Materials and Methods: This historical cohort survival analysis was conducted on 1329 patients diagnosed with breast cancer in Motahari Breast Clinic, Shiraz, Iran between 2004 and 2011. We estimated the rate of survival without recurrence through the Kaplan–Meier method and the difference between the survival curves was investigated using the log-rank test. Furthermore, Cox regression model was used to model the effective factors in local recurrence as well as metastasis. Results: The mean age of the patients was 54.8 ± 11.4 years. Estrogen receptor positive, progesterone receptor positive, and human epidermal growth factor receptor-2 positive were observed in 70.6%, 66.6%, and 34.4% of the cases, respectively. The mean of the follow-up period was 3.7 ± 1.8 years in all patients. The results of the Kaplan–Meier method revealed 1-, 3-, 5-, and 7-year rate of survival without recurrence as 96.4%, 78.4%, 66.3%, and 54.8%, respectively. There was a significant relationship between survival without recurrence and histology grade (hazard ratio [HR] = 1.66, P = 0.009), neural invasion (HR = 1.74, P = 0.006), and progesterone receptors (HR = 0.69, P = 0.031). Conclusion: In this study, the rate of survival without recurrence in breast cancer was 54.8%. Among factors, histology grade and neural involvement at the time of diagnosis increased the chance of recurrence and progesterone receptors caused a longer interval between diagnosis and recurrence

Bilateral Synchronous Male Breast Cancer in Iran: A Case Report

Bilateral synchronous male breast cancer is very rare. A 63-year-old male presented with rapidly progressive enlarging bilateral breast masses without ulceration and bloody nipple discharge. Synchronous bilateral breast cancer was diagnosed by fine needle aspiration cytology. Pathology study revealed grade 2 invasive ductal carcinoma in both breasts. He underwent a bilateral modified radical mastectomy followed by chemotherapy and hormone therapy. The importance of this case report is to create increased attention to the fact that, although rare, breast cancer can occur in males. Early presentation and compliance with treatment modality provide a better outcome